Crowd Funded Health Insurance in Uganda

Posted by Dannielle Noonan

Rwenzori Women for Health is an initiative in Uganda set up by an amazing nurse from the UK, Rita Miller, who works 6 months of each year in Kagando hospital. With a background working for the NHS in the UK, Rita wanted to help areas that weren’t fortunate enough to have a robust public health system, and she has come up with a unique ‘crowd-funded’ medical insurance scheme to help Ugandans.

On Rita’s first day at Kagando hospital she asked the Matron how the communities living in the mountains got healthcare. Her reply? “With great difficulty”. Rita knew then she had to help, but wasn’t sure how… until a chance meeting with Cathy O’Dowd, some 18 months later.

Rita was helped in her efforts with RWFH by adventurous Medibroker customer Cathy O’Dowd, the first woman to summit Everest on both sides. She and three other women set up a foundation called ‘ASTRAIA Female Leadership Foundation’ which has supported RWFH for the past three years.

Rita set up a tiny medical insurance scheme for women in four of the villages, with RWFH matching contributions from the village women, who have got involved with bee-keeping to raise money. The scheme is a fascinating insight into how important medical insurance is and how a community goes about setting it up from scratch.

Healthcare in Uganda

The Ugandan Government Health budget is about £6 GBP per person per year, compared to around £1,500 GBP spent by Government in the UK. Healthcare facilities are varied, so people moving to Uganda for work should ensure they have a private medical plan to get access to the highest standard hospitals.

Though government hospitals in Uganda are supposed to be free, patients are often expected to bring basic supplies, including items like sterile gloves, drugs and dressings. Even then, other basic supplies may not be in stock and there may not always be a doctor available.

Rwenzori Women for Health

The project’s aims are to raise local health standards and provide a point of contact for any health emergencies that may arise. Primarily they offer health prevention/education, which include first aid, perinatal care and family planning. They also run ‘de-worming’ programmes, and test for HIV, diabetes and blood pressure. Rita is working towards standardising care for cervical Cancer across the district - Cancer of the cervix is the biggest cancer killer in Uganda and yet there is no formal screening programme.

RWFH’S lead nurse and other support nursing staff are from Kagando hospital, but the project is independent.

How the Health Insurance Scheme works

Although Kagando hospital tries to keep the fees as low as possible, many don’t come because they either have no money or would rather attend ‘traditional healers’ first, with often terrible outcomes. Rita kept being told that “if a man is sick he will find the money to go to hospital; if the woman or child is sick, there is no money and they suffer in silence.” With this in mind she introduced a small health insurance scheme, linked to the RWFH project.

For a monthly fee of 2000 UGX (equivalent to around 40p) a woman plus one child will be entitled to have half the costs of Outpatients Department (A & E) paid by RWFH. The scheme is also open to female relatives, regardless of where they live in the district. There are now around 130 people registered thanks to an ‘incentive’: if they pay six months they gain one free month. Rita hopes to expand to help inpatients as well, and currently describes her efforts as ‘just a drop in the ocean’.

The Beehive Scheme

RWFH is now trialling a scheme in one of the villages where they give health education talks. In collaboration with Agri Evolve, RWFH gave ten beehives to Kisangani Village: once the honey is sold some proceeds will go to the women who are looking after the hives and the rest to the village to put towards the health insurance scheme. It is through the generosity of donors that RWFH have been able to purchase the beehives… and if successful there will be more busy bees benefiting even more villages.

Kagando Hospital

Kagando is located in the Kasese District, Western Uganda and nestles among the foothills of the Rwenzori Mountains, 20 km from the border with the Democratic Republic of Congo. These are villages only reachable on foot - no roads - where people are so poor they can’t afford to pay fees for the local hospital, and children are often only brought to hospital when it is too late to save them.

Kagando is the only hospital in Kisinga Sub-District and operates in the private sector with obligations to the Government for some public health functions and for its training and service standards. A Church of Uganda hospital, the doctors and staff wages are funded mainly through the patients fees but Friends of Kagando subsidise this.

Thanks to fundraising, Kagando almost always has doctors, well trained and conscientious nurses and supplies. It functions reliably as a hospital and consequently has a reputation that extends well outside its own catchment area with patients often passing other hospitals to reach it. Nobody is ever turned away.

Over the years, Kagando has expanded to provide surgical and medical wards, paediatric, neonatal wards and maternity wards, including an out patients’ department. It also provides support services for women with complete incontinence following childbirth (obstetric fistula), a not uncommon problem in the whole of sub-Saharan Africa though excessively rare in developed nations. The hospital also acts as a base for many community services and preventative health projects. There are outreach services already in place: HIV/Aids, palliative care, TB, leprosy and disabilities.

The hospital has 250 beds and averages about 20,000 annual outpatient visits and about 18,000 annual inpatient admissions.

Rita has a facebook site called Kagando Care. Any funds for RWFH sent via Friends of Kagando must always be earmarked for the charity as they do receive donations for other projects.